ABOUT LIVER TRANSPLANT
Liver Transplantation is a sophisticated, effective
therapy for end stage liver disease. In this procedure,
a patient’s diseased liver is removed and replaced
with a healthy liver from a recently deceased organ
donor or a live donor. The liver transplant program at
Duke University Medical Center began in 1984. Since
then, we have performed over 900 liver transplant
procedures. Our work in this exciting field has also
enhanced the prospects of liver transplant patients
around the nation by contributing to advancements in
transplant techniques, treatments, and research.
For many patients and their families, the prospect of
undergoing a liver transplant makes them a little
anxious and uncertain. This information may help
relieve some of those feelings by explaining what you
may experience as a liver transplant patient at Duke.
We have included information about your health prior
to surgery, the surgery, and what to expect during your
recovery.
This information is intended to answer many of your
questions. However, you may find that you have
several more. If so, we suggest that you write your
questions in the space provided in the last section.
Some patients start a note book for information. This
will help you remember to discuss your questions with
the members of the transplant team at your clinic
visits.
About Your Liver
The liver is the largest and most important organ in
the body. It is located under the rib cage on the right
side of you body. It serves many purposes, but there
are three that are most important. First, the liver
receives all of the blood and nutrients absorbed from
the intestine. The liver acts like a processing station
for these nutrients. In addition, any toxins absorbed
from the intestine are neutralized in the liver. Second,
the liver produces bile that is emptied into the
intestine through bile ducts that connect the liver to
the intestine. The bile is required to help the
intestines digest all of the food that you can eat.
Liver Donation and Allocation
Finally, the liver is the factory that produces almost all
of the proteins found in your blood. These proteins
help your body perform many of its important
functions like helping you to clot your blood after you
cut yourself, and helping the body fight off infection.
Because the liver does so many different things, when
it doesn’t work many of the normal functions of your
body break down. You can’t process nutrients from
your intestines and therefore you may develop fatigue
and weakness. Fluid may build up in your abdomen
because of abnormal blood flow in the liver. These
and other symptoms may appear as your liver function
worsens. All of these problems may be reversed with
a transplanted liver.
Reasons for Transplantation
Liver transplantation is indicated when the liver is so
diseased that it can no longer perform vital functions
and when the liver disease cannot be corrected in any
other way. The causes of end-stage liver disease vary.
The following liver diseases are common reasons for
transplantation:
Alcoholic Cirrhosis
Alpha-1 Antitrypsin Deficiency
Autoimmune Hepatitis
Biliary Atresia
Hepatitis B
Hepatitis C
Primary Biliary Cirrhosis
Sclerosing Cholangitis
Some other liver diseases may also lead to liver
transplantation. Most patients have chronic disease
that over many years leads to cirrhosis. Cirrhosis is
irreversible scarring of the liver.
When listed as a candidate for liver transplantation,
your name is placed on a national transplant list.
All transplant candidates in the country are listed in
a national donor computer system through the
United Network for Organ Sharing (UNOS). The
Carolina Donor Service (CDS) works with UNOS to
coordinate transplants in this region of North
Carolina. Donor livers are matched with recipients
according to the following criteria:
 Blood type (O, A, B, or AB)
 Body size
 Severity of disease
Quality of the donor liver is of the utmost priority; it
must be healthy and without evidence of damage or
disease. Before the liver is accepted for a
transplant, it is thoroughly evaluated. This
evaluation includes examination of the donor’s
medical history, social history, and liver function
studies. Donors are also carefully tested to be as
sure as possible that they have no transmissible
disease, such as AIDS, hepatitis or cancer.
When a donor liver becomes available, it is given to
the sickest person on the waiting list who matches
the donor size and blood type. How sick you are is
based on a score (called MELD score) that is
calculated using recent blood work results. These
results are entered into the national waiting list
computer when you come
to clinic or have labs done at home at our request.
You may need blood work done without seeing the
doctor at times so we may recertify your score in
the computer.
Living Donation
Living liver donation has become one method of
creating more donors for those who may not be
able to wait for a deceased donor. Living donors
may be related or have a close personal
relationship with the person who is sick. Living
donation allows part of the liver of an adult donor to
be removed and transplanted into the person with
liver disease.
By 90 days, both the transplanted portion of the
liver, and the donor’s residual liver will have grown
to full size. All functions that the liver performs will
be able to be completed by both parts of the liver.
There have been several thousand of these
procedures performed in the United States.
Donors must be in excellent health to donate.
Careful assessment and evaluation is given to both
the donor and the recipient to ensure that each
person will be able to survive and that each will
have no other effects from such a large procedure.
Your hepatologist or nurse coordinator is available
to speak with you about living donation options
after you are listed for transplant.
Waiting for Your Transplant
Unfortunately, there are more people waiting for a
liver transplant than there are livers donated each
year. Because of the small number of donors, the
waiting period for a liver transplant varies. How
long you wait will depend upon your blood type and
the severity of your liver disease. We have no way
to predict when you will get a liver transplant. This
period is understandably frustrating, stressful, and
can be discouraging.
It’s important to remember during this difficult time
that no one has any control over when a donor liver
becomes available. You will be seen in the Liver
Transplant Clinic during your pre-transplant waiting
period on a regular basis to be sure you are not
having worsening complications of your liver
disease. Our goal is to maintain your health at the
best possible level so you will be able to have a
transplant when available. While you are waiting,
we strongly encourage you to participate in an
exercise program. Physical exercise will help you
maintain your strength and endurance in
preparation for your transplant, and increase your
chances to do well afterward. Good nutrition is also
a must while you wait for your new liver. A
nutritionist is available as a resource for diet
counseling.